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P Form C M109: Statement of Municipal Candidate Not Raising or Expending Campaign�-Fvnd.s Commonwealth of Massachusetts Office of Campaign and PoRtical Finance �' } ¢ #t , File with: Local Election Official(City or Town Clerk) Candidate's Name: S A�W Office Sought: <,at�QOL" Residential Address: f 01fq rlo city/state/zip: E-Mail Address: -V-vv\- Wone Number: 6 4 TTJ I hereby certify that i have not opened a campaign bank account for campaign funds be I do not intend to accept contributions or in-kind contributions,make expenditures,including expenditures of my own fands,or incur liabilities for any cajunpaign-related purpose, nor do I currently have any outstanding liabilities for prior campaign-related activity. I submit the following as my campaign report for all bank reporting periods in this calendar Year as provided for m* Chapter 55 of the Massachusetts General Laws: 1, Ending balance from previous report ZERO 2. Total receipts for reporting period ZERO 3. Subtotal ZERO 4. Total Expenditures for reporting period ZERO 5. Ending balance ZERO After filing this statement,if I decide to raise,accept,or expend funds,or incur liabilities,for a campaign-related purpose,I will immediately notify my local election official in writing', and will fileperiodic campaign finance reports according to the statutory filing schedule. Until such notice is on file with the local election official,I certify that the above Zero report will be in effect for each reporting period, in the calendar year in which it is filed,required by Chapter 55 of the Massachusetts General Laws. This form is valid through December 31 of the year in which it was signed. 'Ilk ctoo,,7� C% 4-o �.. SIGNED INTI] R TIS P NK TIES OF RYIII,� C-� Candidate's signature: Date:_ � M109 12121